Cardiac rhythm management system with atrial shock timing optimization

A method comprising:

• detecting an atrial tachyarrhythmia;
• stabilizing a ventricular heart rate, using an infinite impulse response filter to filter intervals between paced or sensed ventricular depolarizations to compute an indicated ventricular pacing interval on a beat-to-beat basis, in response to the detecting the atrial tachyarrhythmia;
• determining whether potentially proarrhythmic conditions exist;
• and
• delivering cardioversion/defibrillation therapy to the atrium, in response to the detecting the atrial tachyarrhythmia, if the determining whether potentially proarrhythmic conditions exist indicates that no potentially proarrhythmic conditions exist, otherwise withholding the delivery of cardioversion/defibrillation therapy to the atrium until no potentially proarrhythmic conditions exist.

A cardiac rhythm management system, comprising:

• an atrial heart signal sensing circuit;
• a ventricular heart signal sensing circuit, configured to sense V—V intervals between ventricular depolarizations of a ventricle;
• a ventricular pacing therapy circuit;
• an atrial cardioversion/defibrillation therapy circuit;
• and
• a controller, communicatively coupled to the atrial heart signal sensing circuit, the ventricular heart signal sensing circuit, the ventricular pacing therapy circuit, and the atrial cardioversion/defibrillation therapy circuit, the controller including:
• a ventricular rate stabilization circuit, including an infinite impulse response (IIR) filter circuit outputting a variable indicated pacing interval, the IIR filter circuit using at least first input comprising a duration of a most recent sensed V—V interval and a second input comprising a preceding value of the indicated pacing interval;
• and
• an atrial cardioversion/defibrillation control circuit that (a) determines if potentially proarrhythmic ventricular conditions exist, and (b) includes an atrial therapy circuit that delivers cardioversion/defibrillation therapy to the atrium if no potentially proarrhythmic conditions exist, and otherwise withholds the delivery of cardioversion/defibrillation therapy to the atrium.

A method comprising:

• detecting an atrial tachyarrhythmia;
• stabilizing a ventricular heart rate, using an infinite impulse response filter to compute an indicated ventricular pacing interval, in response to the detecting the atrial tachyarrhythmia;
• determining whether potentially proarrhythmic conditions exist, including:
• comparing a most recent V—V interval to a first predetermined value;
• deeming no potentially proarrhythmic conditions to exist if the most recent V—V interval is longer than or equal to a first predetermined value;
• deeming no potentially proarrhythmic conditions to exist if the most recent V—V interval is shorter than the first predetermined value and the most recent V—V interval exceeds or equals a preceding V—V interval less a second predetermined value;
• deeming potentially proarrhythmic conditions to exist if the most recent V—V interval is shorter than or equal to a third predetermined value;
• and
• deeming potentially proarrhythmic conditions to exist if the most recent V—V interval is longer than the third predetermined value and the most recent V—V interval is shorter than the preceding V—V interval less the second predetermined value;
• and
• delivering cardioversion/defibrillation therapy to the atrium, in response to the detecting the atrial tachyarrhythmia, if the determining whether potentially proarrhythmic conditions exist indicates that no potentially proarrhythmic conditions exist, otherwise withholding the delivery of cardioversion/defibrillation therapy to the atrium until no potentially proarrhythmic conditions exist.

A method comprising:

• detecting an atrial tachyarrhythmia;
• stabilizing a ventricular heart rate, using an infinite impulse response filter to compute an indicated ventricular pacing interval, in response to the detecting the atrial tachyarrhythmia;
• determining whether potentially proarrhythmic conditions exist, including:
• comparing a most recent V—V interval to a first predetermined value, in which the first predetermined value is different when the most recent V—V interval is initiated by a sensed beat than when the most recent V—V interval is initiated by a paced beat;
• deeming no potentially proarrhythmic conditions to exist if the most recent V—V interval is longer than a first predetermined value;
• deeming no potentially proarrhythmic conditions to exist if the most recent V—V interval is shorter than the first predetermined value and the most recent V—V interval exceeds or equals a preceding V—V interval less a second predetermined value;
• deeming potentially proarrhythmic conditions to exist if the most recent V—V interval is shorter than a third predetermined value;
• and
• deeming potentially proarrhythmic conditions to exist if the most recent V—V interval is longer than the third predetermined value and the most recent V—V interval is shorter than the preceding V—V interval less the second predetermined value;
• and
• delivering cardioversion/defibrillation therapy to the atrium, in response to the detecting the atrial tachyarrhythmia, if the determining whether potentially proarrhythmic conditions exist indicates that no potentially proarrhythmic conditions exist, otherwise withholding the delivery of cardioversion/defibrillation therapy to the atrium until no potentially proarrhythmic conditions exist.

A method comprising:

• detecting an atrial tachyarrhythmia;
• stabilizing a ventricular heart rate, using an infinite impulse response filter to compute an indicated ventricular pacing interval, in response to the detecting the atrial tachyarrhythmia;
• determining whether potentially proarrhythmic conditions exist, including:
• comparing a most recent V—V interval to a first predetermined value;
• deeming no potentially proarrhythmic conditions to exist if the most recent V—V interval is longer than a first predetermined value;
• deeming no potentially proarrhythmic conditions to exist if the most recent V—V interval is shorter than the first predetermined value and the most recent V—V interval exceeds or equals a preceding V—V interval less a second predetermined value, in which the second predetermined value is different when the most recent V—V interval is initiated by a sensed beat than when the most recent V—V interval is initiated by a paced beat;
• deeming potentially proarrhythmic conditions to exist if the most recent V—V interval is shorter than a third predetermined value;
• and
• deeming potentially proarrhythmic conditions to exist if the most recent V—V interval is longer than the third predetermined value and the most recent V—V interval is shorter than the preceding V—V interval less the second predetermined value;
• and
• delivering cardioversion/defibrillation therapy to the atrium, in response to the detecting the atrial tachyarrhythmia, if the determining whether potentially proarrhythmic conditions exist indicates that no potentially proarrhythmic conditions exist, otherwise withholding the delivery of cardioversion/defibrillation therapy to the atrium until no potentially proarrhythmic conditions exist.

A method comprising:

• detecting an atrial tachyarrhythmia;
• stabilizing a ventricular heart rate, using an infinite impulse response filter to compute an indicated ventricular pacing interval, in response to the detecting the atrial tachyarrhythmia;
• determining whether potentially proarrhythmic conditions exist, including:
• comparing a most recent V—V interval to a first predetermined value;
• deeming no potentially proarrhythmic conditions to exist if the most recent V—V interval is longer than a first predetermined value;
• deeming no potentially proarrhythmic conditions to exist if the most recent V—V interval is shorter than the first predetermined value and the most recent V—V interval exceeds or equals a preceding V—V interval less a second predetermined value;
• deeming potentially proarrhythmic conditions to exist if the most recent V—V interval is shorter than a third predetermined value, in which the third predetermined value is different when the most recent V—V interval is initiated by a sensed beat than when the most recent V—V interval is initiated by a paced beat;
• and
• deeming potentially proarrhythmic conditions to exist if the most recent V—V interval is longer than the third predetermined value and the most recent V—V interval is shorter than the preceding V—V interval less the second predetermined value;
• and
• delivering cardioversion/defibrillation therapy to the atrium, in response to the detecting the atrial tachyarrhythmia, if the determining whether potentially proarrhythmic conditions exist indicates that no potentially proarrhythmic conditions exist, otherwise withholding the delivery of cardioversion/defibrillation therapy to the atrium until no potentially proarrhythmic conditions exist.